Director, Utilization Management & Care Coordination

St Luke's Health; Houston (TX); On-site; USD 130,000 - 190,000; Full time

Job summary

Baylor St. Luke’s Medical Center is seeking a senior Utilization Management Director to lead the market development, implementation, and evaluation of the UM program within the CommonSpirit Health Care Coordination model.

The role directs staff, ensures compliance with payer requirements, drives accreditation readiness, and partners with the Division Director Care Coordination to achieve organizational goals.

Qualifications

• Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
• Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination).
• 5 years of progressively responsible management experience.
• Extensive operational experience in managed care; program planning, staff development, and needs assessment.
• Comprehensive knowledge of utilization management and payer/regulatory requirements.

Responsibilities

• Lead market development, implementation, evaluation and direction of the Utilization Management Program.
• Oversee UM policies, procedures and processes; ensure accreditation activities and regulatory compliance.
• Direct staff to meet performance standards and align with payer requirements and organizational goals.

Skills

Clinical case management

Management experience

Operational experience

Care coordination

Education

Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree

Job description

Baylor St. Luke’s Medical Center is seeking a senior Utilization Management Director to lead the market development, implementation, and evaluation of the UM program within the CommonSpirit Health Care Coordination model.

The role directs staff, ensures compliance with payer requirements, drives accreditation readiness, and partners with the Division Director Care Coordination to achieve organizational goals.